Meneveau, Nicolas
Guillon, Benoit
Planquette, Benjamin
Piton, Gael
Kimmoun, Antoine
Gaide-Chevronnay, Lucie
Aissaoui, Nadia
Neuschwander, Arthur
Zogheib, Elie
Dupont, Herve
Pili-Floury, Sebastien
Ecarnot, Fiona
Schiele, Francois
Deye, Nicolas
de Prost, Nicolas
Favory, Raphael
Girard, Philippe
Cristinar, Mircea
Ferre, Alexis
Meyer, Guy
Capellier, Gilles
Sanchez, Olivier
Aims The role of extracorporeal membrane oxygenation (ECMO) remains ill defined in pulmonary embolism (PE). We investigated outcomes in patients with high-risk PE undergoing ECMO according to initial therapeutic strategy. Methods and results From 01 January 2014 to 31 December 2015, 180 patients from 13 Departments in nine centres with high-risk PE were retrospectively included. Among those undergoing ECMO, we compared characteristics and outcomes according to adjunctive treatment strategy (systemic thrombolysis, surgical embolectomy, or no reperfusion therapy). Primary outcome was all-cause 30-day mortality. Secondary outcome was 90-day major bleeding. One hundred and twenty-eight patients were treated without ECMO; 52 (mean age 47.6 years) underwent ECMO. Overall 30-day mortality was 48.3% [95% confidence interval (CI) 41-56] (87/180); 43% (95% CI 34-52) (55/128) in those treated without ECMO vs. 61.5% (95% CI 52-78) (32/52) in those with ECMO (P =3D 0.008). In patients undergoing ECMO, 30-day mortality was 76.5% (95% CI 57-97) (13/17) for ECMO+fibrinolysis, 29.4% (95% CI 51-89) (5/17) for ECMO+surgical embolectomy, and 77.7% (95% CI 59-97) (14/18) for ECMO alone (P =3D 0.004). Among patients with ECMO, 20 (38.5%, 95% CI 25-52) had a major bleeding event in-hospital; without significant difference across groups. Conclusion In patients with high-risk PE, those with ECMO have a more severe presentation and worse prognosis. Extracorporeal membrane oxygenation in patients with failed fibrinolysis and in those with no reperfusion seems to be associated with particularly unfavourable prognosis compared with ECMO performed in addition to surgical embolectomy. Our findings suggest that ECMO does not appear justified as a stand-alone treatment strategy in PE patients, but shows promise as a complement to surgical embolectomy.
Lecronier, Marie
Valade, Sandrine
Bige, Naike
de Prost, Nicolas
Roux, Damien
Lebeaux, David
Maury, Eric
Azoulay, Elie
Demoule, Alexandre
Dres, Martin
Background: While no data support this practice, international guidelines recommend the removal of totally implanted venous access ports (TIVAPs) in patients with suspicion of TIVAP-related bloodstream infection admitted in the intensive care unit (ICU) for a life-threatening sepsis. Methods: During this multicenter, retrospective and observational study, we included all patients admitted in five ICU for a life-threatening sepsis in whom a TIVAP was removed between January 2012 and December 2014. We aimed (1) at determining the proportion of confirmed TIVAP-related infections and (2) at assessing short- and long-term survival of patients with and without TIVAP-related infections. Results: One hundred and fifty-one patients (58 +/- 14 years, 62% males) were included between 2012 and 2014. TIVAP-related infections were confirmed in 68 patients (45%). Demographic characteristics were similar between patients with and without TIVAP-related infections. SOFA score on admission per point increase [odd ratio (OR), 0.86 interval confidence (IC) 95% (0.8-0.9), p < 0.01] and local signs of infection [OR 4.0, IC 95% (1.1-15.6), p =3D 0.04] were significantly associated with TIVAP-related infection. Patients with TIVAP-related infection had lower ICU and 6-month mortality as compared to their counterparts (9 vs. 40%, respectively, p < 0.01; and 50 vs. 66%, respectively, p =3D 0.04). TIVAP-related infection was significantly associated with ICU survival [OR 0.2, IC 95% (0.05-0.5), p < 0.01]. Conclusions: TIVAP-related infection was confirmed in nearly one out of two cases of life-threatening sepsis in patients in whom it has been removed. TIVAP-related infection was associated with a good prognosis, as compared to patients with other causes of infection.
Mekontso Dessap, Armand
Jansen, Chloe
Boissier, Florence
Razazi, Keyvan
de Prost, Nicolas
Michaud, Gael
Cizeau, Florence
Ducellier, David
Abid, Shariq
Decousser, Jean-Winoc
Brun-Buisson, Christian
Contamination of a point-of-care ultrasound system (POCUS) mainly involved electrocardiography accessories and included pathogenic microorganisms. The use of a glass-sealed control panel significantly facilitated its cleaning and reduced its bacterial contamination compared with a standard control panel. Overall hand hygiene compliance during examinations with POCUS was poor. =20
This article analyzes several stylized facts and implications concerning intra-party violence developed in the other articles of this special issue on intra-party violence in African electoral systems. It then turns more specifically to the implications of intra-party violence for democratic consolidation in the region, and argues that paradoxically, though parties are centrally important to democratic politics, the degree to which they are internally inclusive and participatory may not have much importance, or may indeed undermine democracy. Though they are perhaps the key actor on the path to a consolidated democracy, they tend to work best when they themselves are not internally democratic.
Nicolas de Beguelin, philosopher and scientist and a member of the Berlin Academy, undertook to conciliate such conflicting views concerning the foundations of natural philosophy as seemed to suggest an irreducible antinomy between the Leibnizian-Wolffian and the Newtonian principles. In a series of memoirs, he argued that experimental philosophy would remain unsettled about the validity of its hypotheses as long as it failed to check them against requisites arising from architectonic principles and their source in sufficient reason. At the heart of his argument, one finds an analysis of the relationship that holds between laws of nature and contingent truths. Case studies were provided relative to the "deduction" of the fundamental laws of mechanics : these should be in no way equated with abstract statements featuring geometrical necessity. Relying on the requisites of universal harmony, Beguelin framed up hypotheses concerning the integration of motive forces underpinning inertia, as well as concerning space as an order of coexistent bodies that would depend on the interrelation between monadic elements.